Provider Demographics
NPI:1285762823
Name:COOK, STEPHANIE ANN (BS)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:COOK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:KIMBRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:712 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2828
Mailing Address - Country:US
Mailing Address - Phone:931-684-0522
Mailing Address - Fax:931-684-6238
Practice Address - Street 1:712 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2828
Practice Address - Country:US
Practice Address - Phone:931-684-0522
Practice Address - Fax:931-684-6238
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator